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To complicate matters, in the midst of the furor over the AIDS report, Koop awoke from a nap one afternoon to find himself essentially quadriplegic-he could move neither hands nor feet, due to a damaged vertebra, aggravated by years of bending over while operating on infants. Surgeons repaired most of the damage, but recuperation kept him in bed for the next several weeks.

Surprising friends and foes

Koop now looks back on that time of enforced inactivity—like the nine-month nomination process—as a providential gift. He began to see that AIDS was one disease in which the moralist and the scientist could work, indeed, needed to work, hand in hand to contain the epidemic. "For seven weeks I watched the impact of what had been done as reported in the press. I made up my mind that I had an obligation and a chore, and so I decided to do something that probably nobody else ever has done in public office. For the first seven weeks in 1987 I addressed only religious groups. I started with Jerry Falwell's church and the chapel at Liberty University, went to the National Religious Broadcasters' convention, talked to conservative people in Judaism, and to Roman Catholics, and ended up with a series of radio shows for Moody Broadcasting Network."

In those addresses, delivered in full uniform and a neck brace, Koop affirmed the need for abstinence and monogamous marriage. But he added, "Total abstinence for everyone is not realistic, and I'm not ready to give up on the human race quite yet. … I am the surgeon general of the heterosexuals and the homosexuals, of the young and the old, of the moral and the immoral." He admonished, "You may hate the sin, but you are to love the sinner." While Koop expressed his personal abhorrence of sexual promiscuity—consistently he has used the word sodomy when referring to homosexual acts—he also insisted, "I'm the surgeon general, not the chaplain general."

To explain his position, he often used the analogy of an emergency-room physician. If an ambulance pulls up and unloads two wounded men, a bank robber who shot a guard and the bank guard who returned fire, which man does the doctor treat first? He must go to the man with the most urgent wounds, not the most moral one. Koop had seen enough homosexual AIDS patients, their bodies gaunt, emaciated, and covered with purplish sores, to know who needed the most urgent treatment. He had vowed to look out for the weak and disenfranchised—and there was no group more weak or disenfranchised in the nation. Regardless of the political cost, he would defend their right to treatment, and work to educate them on preventing this deadly disease.

The surgeon general lost much support among political conservatives over the AIDS issue. But he now looks back with pride on the attitude of the roots church. "I really think we turned people around on this issue," he says. Surveys revealed a public more open to sex education in the schools. Koop saw denominations design their own sex-education curricula, and form programs to minister to the AIDS patients.

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The Embattled Career of Dr. Koop